More time to care?
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More time to care?
Reducing the travelling time of community nurses may be one way to improve the efficiency of the NHS ..or ¡s it? Donald Waters
The route/n g of people, vehicles or work-in-progress
direct nursing while staying within financial limits. The data collected implies that the 195 nurses travelled over three-quarters of a million miles each year. Reductions in this could give benefits in two ways:
Computerized vehicle route/n g may lead to
more time would be available for direct nursing; and
through a number of visits or tasks is a common logistical problem. In the case of community nurses, it/s desirable to minimize travelling time between patients, in order to increase time for direct patient care and to reduce costs.
improvements, but the relative costs and benefits of any proposed system need to be evaluated carefully before-
any money saved on the variable cost of travel could be used to improve nursIng care.
hand. As in many OR inteiventions, a prellmlnaiy pilot
To assess the feasibility of computerized routeing,
study can be invaluable.
savings achieved with several levels of computer
Several types of community nurses (midwives, district nurses, health visitors, school nurses, etc.) have to travel to visit patients. If their main function is to provide direct
involvement were examined:
minor changes were made to existing routes, to improve poor quality routes but maintain current
nursing, their 'efficiency' can be measured by the
nursing patterns;
proportion of their time spent doing this. In 1982 data was
collected in the West of Scotland from 195 nurses,
major changes were made to existing routes, but the
analysis gave the proportions of time spent by the nurses on various activities shown in Table 1 below:
unchanged; and
allocation of patients to nurses remained
covering 54,000 miles and 18,400 visits. Subsequent
major changes were made to existing routes,
Table 1: Proportion of time spent on various activities Activity Nursing at patients' homes (direct nursing) Travelling Clerical work Liaison and consultation (indirect nursing) Preparation Relaxation
redistributing patients to nurses without regard to existing allocations.
The pilot study
Percentage of time (%)
A pilot study was used to assess the effects of
computerized routeing on a few nurses over a limited period. For this study, a group of three nurses was identified who worked in a coherent area centred on
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Stranraer and who all travelled relatively long distances. A seven- day period was found when all three were on duty and no unusual circumstances were reported.
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cover their rural area, and the only feasible way of
The selected nurses used mainly unclassified roads to
constructing the necessary matrix of distances was to establish a conversion factor between map references and travel distances. Distances of actual journeys were compared with straight-line distances measured on ordnance survey maps, and a line of best fit was found with a correlation coefficient of 0.95. The straight-lin
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